Stoner barf: Yes, it’s a thing, and it’s way more common than you think

Marijuana has long been lauded as a wonder drug for treating nausea and vomiting. Now, health experts say your pot may be making you sick.

Emergency medicine physicians at UC Davis Medical Center said they’ve seen young, often college-age patients come in once or twice a day vomiting multiple times an hour and screaming uncontrollably.

“They keep moaning, shouting and yelling after they vomit. It’s very dramatic. It sounds like someone is dying,” said Dr. John Richards, an emergency medicine physician and professor at UC Davis.

Doctors have seen these symptoms in emergency rooms for years without fully understanding what was happening, he said. Ultrasounds and CT scans would be ordered, and opioids and anti-nausea medication prescribed, but to no avail. It wasn’t until a 2004 study, when Australian doctors identified a connection between patients’ marijuana use and their recurring episodes of vomiting and abdominal pain that the diagnosis was clinched.

Blazing up every day with potent strains of marijuana was eliciting the symptoms, according to the study.

THC and other cannabinoid concentrations are also higher in medical marijuana strains, which may be contributing to more cases of CHS.

“Imagine you have a beer every day and then one day I give you 100 proof alcohol and I say, ‘Go at it,’ ” said Dr. Jeff Lapoint✔, a toxicologist and emergency medicine physician in San Diego. “That’s similar to the effect potent marijuana strains have.”

The condition is known as cannabinoid hyperemesis syndrome, or more simply CHS, and doctors believe it’s caused when cannabinoids in marijuana — a chemical that bonds to receptors in the central nervous system — bombard neurotransmitters, causing an imbalance in the body’s regulatory system.

Cannabinoids are naturally present within the body and they interact with a complex system of endocannabinoid receptors. But when someone inhales marijuana, they’re getting a spike in cannabinoids, especially THC, the cannabinoid responsible for highs. That inundates the body’s cannabinoid receptors, causing them to shrink back into cells. Other neurotransmitter receptors kick into overdrive to compensate for the overworked cannabinoid receptors.

The physical pain and psychological stress of repeated vomiting can send people into emergency rooms writhing and screaming, said Dr. Aimee Moulin, emergency medicine physician and associate professor at UC Davis.

Not a single case has been reported after throwing back edible pot, however. “Eating pot releases cannabinoids at a slower rate,” Lapoint said. “And most people don’t eat multiple edibles in a space of a few hours, while people often smoke marijuana at least a couple times a day.”

CHS typically only affects a small number of chronic pot smokers, but it’s become the subject of more attention since pot is now the most commonly used federally prohibited drug in the U.S., according to the the U.S. Centers for Disease Control and Prevention.

Doctors noticed an uptick of CHS cases after the legalization of medical marijuana, Moulin said.

And after the November election, recreational marijuana became legal in eight states, including California. Richards said he anticipated seeing more cases, which means it’ll be important to know more about the condition.

“It’s good for physicians to know because when they treat people with traditional methods and when they don’t work, they think something is really wrong,” he said.

The key signs of CHS are regular pot use and compulsive bathing. Scalding hot baths and showers have been shown to be an effective treatment because the hot water redirects blood flow from an irritated stomach to the skin, Richards said.

Lapoint recalled a 19-year-old woman who had been to the emergency room two days in a row and had run through a number of tests without a successful diagnosis.

“I heard her screaming down the hallway,” he said. “She started kicking and screaming on the bed. People with appendicitis or belly pain don’t do that. So I asked her about her marijuana use and she said she had been smoking a high potency strain a couple times a day for months. Then I asked her if hot showers helped and she said they did. So that nailed the diagnosis.”

Lapoint said he applied a capsaicin cream — which contains the same ingredients as chili peppers — to her stomach since hot temperatures relieve related stomach discomfort and stop the vomiting.

She was on her way home within 45 minutes, capsaicin cream in hand, Lapoint said.

Only one long-term treatment, however, has the best chances of success: putting aside the bong or blunt for good.

“It’s counterintuitive because marijuana is something they use to fight nausea, and now I have to tell them it’s marijuana that’s making them sick,” Lapoint said.

Since marijuana is ranked on par with cocaine and heroin by the Drug Enforcement Administration, the long-term effects of marijuana have not been studied in great length because the federal prohibition of marijuana limits research, Moulin said.

“A lot of the research is federally funded, and the federal scheduling of marijuana as not a medical substance really inhibits your ability as a researcher to obtain funding and authorization to study marijuana,” she said. “It’s an obstacle for studying the side effects and efficacy of the different compounds of marijuana.”

Richards and Moulin, along with two other doctors at UC Davis, have found anti-anxiety and anti-psychotic medications are also effective in treating CHS. That’s in part because cannabinoids are stored in fat cells. When under stress, the fat cells break down, releasing a blitz of cannabinoids into the bloodstream.

Anti-anxiety medications help interrupt the release of more cannabinoids into the blood, Richards said.

“It’s super super complex,” Lapoint said. “There’s so many variables to account for when trying to understand the body’s endocannabinoid system.”

Smoking too much marijuana can cause repeated vomiting and intense abdominal pain. With the legalization of pot in California and more potent strains, emergency rooms are seeing more cases of cannabinoid hyperemesis syndrome. Robert F. BukatyAP

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